Glossary of Terms

This is the amount you are responsible for paying (for non-preventive care services) before the medical/prescription or dental plan will begin to contribute to your expenses each year. If you have individual coverage, the plan starts sharing the cost with you through coinsurance when you reach the individual deductible. If you are enrolled in family coverage (employee plus spouse, employee plus child(ren), employee plus family), no family member will pay more than his/her individual deductible. All family members’ expenses also accumulate toward the family deductible. Once the family deductible is met, the plan will share the cost through coinsurance for all covered family members. As a reminder, there is a combined deductible for medical and prescription benefits.

This is a unit of measurement used to determine your disability, basic life and basic AD&D coverage, as well as the amount of supplemental life and AD&D insurance you are eligible to elect.

When new drugs come on the market, they are protected by a patent for a certain period of time, which means no other companies can copy the formula. After the patent ends, other companies can make and sell generics using the same formula and active ingredients. Brand name drugs are typically more expensive than their generic counterparts.

This percentage is your share of the cost of each covered health care service or prescription. Once you’ve met your annual deductible, you and the medical/prescription plan share in the cost of covered services or prescriptions until you meet your out-of-pocket maximum.

Dependents are associates’ family members who are eligible to be enrolled in the ABC Company’s benefits plans according to the plan rules on page one.

As a result of contract negotiations with in-network providers, benefit vendors secure discounts on services that lower the costs below the cash price (the price you would pay if you didn’t have insurance). These savings are passed on to you, meaning instant savings when you use your elected benefits with an in-network provider or facility.

If you elect more supplemental life insurance than the maximum guaranteed coverage level, or if you increase your current election during annual enrollment, you will be required to submit a form proving your good health and be approved by the insurance carrier to receive the coverage. You are also subject to EOI if you elect short or long-term disability and did not have the coverage previously.

When a claim is filed for medical or dental services, United Healthcare will send you an EOB. The EOB explains the cost of your claim, how much the plan paid and any remaining balance for which your provider may send you a bill. You should never pay a bill from a provider without comparing it to the EOB first.

Once a brand name drug’s patent ends, other companies can produce similar drugs (generic drugs). They have the same active ingredients as their brand name counterparts and have been approved by the Food and Drug Administration (FDA) as safe and effective, but they typically cost much less.

This refers to facilities, providers and pharmacies within the United Healthcare (medical and prescription), United Healthcare (dental) or VSP (vision) networks. These benefit vendors have negotiated cost and quality expectations for their in-network providers. The plan will share more of the cost and you will generally pay less than if you went out of network.

This is the maximum amount you are responsible for paying for medical/prescription expenses after your combined medical/prescription plan annual deductible has been met. If you have individual coverage, you will not pay more than your individual out-of-pocket maximum. If you are enrolled in family coverage (associate plus spouse, associate plus child(ren), associate plus family), you will not pay more than the individual out-of-pocket maximum for a particular family member, and that individual’s out-of-pocket maximum will count toward the family out-of-pocket maximum. Once you’ve met the applicable out-of-pocket maximum (individual or family), the plan will pay 100% of eligible medical/prescription plan expenses for the remainder of the calendar year.

This is our prescription plan’s list of medications that are preferred based on their quality and price.